From the Guidelines
Male neonatal circumcision can lead to complications such as pain and anxiety, which can be mitigated with proper pain management techniques.
Common Complications
- Pain and anxiety during and after the procedure, which can be managed with topical anesthetics, as they are safe in newborn infants and even preterm infants, with appropriate dosing and short administration times 1
Management of Complications
Proper protocols for topical anesthetic placement should include neonates to minimize painful stimuli for infants, and recent studies have suggested methods by which neonatal distress during painful procedures can be minimized 1.
Important Considerations
It is essential to consider the potential complications of male neonatal circumcision and take steps to minimize them, particularly in terms of pain management, to ensure the best possible outcomes for the infant.
From the Research
Complications of Male Neonatal Circumcision
- The complications of male neonatal circumcision can be categorized into early and late complications 2
- Early complications include bleeding, infection, and hematoma, while late complications include meatal stenosis, meatal web, and incomplete removal of the prepuce 2, 3
- The risk of complications is higher in neonates than in children, with a relative risk of 2.6 (95% CI 1.46-4.71, p<0.001) 2
- The most common complications of Plastibell circumcision are retained ring, excess skin, bleeding, infection, and hematoma, with an overall complication rate of 4.4% in neonates and 17% in infants (P < 0.001) 4
- Other complications that can occur after neonatal circumcision include penile adhesions, skin bridges, redundant foreskin, recurrent phimosis, buried penis, and penile rotation 3
Frequency of Complications
- Complications develop in approximately 1 of every 200 procedures 5
- A retrospective cohort study found that complications occurred in 61 boys (12.7%), with 40 neonates (8.3%) and 21 children (4.4%) experiencing complications (p˂0.001) 2
- Another study found that 424 (4.7%) of 8,967 children operated on during the study period were for complications resulting from previous neonatal circumcision 3
Prevention and Recommendations
- Practitioners should provide comprehensive information about the risks and benefits of circumcision to parents, who should weigh up the risks and benefits and make the best decision regarding their personal beliefs and customs 2
- The American Academy of Pediatrics and the American Academy of Family Physicians recommend continued access to circumcision on an elective basis and conclude that the benefits outweigh the risks, but do not endorse routine neonatal circumcision 5
- Circumcision should be performed by practitioners with adequate training in the technique of their choice and its post-operative care 3